A Tale of an Applications Evolution Dr David Evans Mr Paul - - PowerPoint PPT Presentation

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A Tale of an Applications Evolution Dr David Evans Mr Paul - - PowerPoint PPT Presentation

The Future of The Electronic Discharge Summary HIC 2015 A Tale of an Applications Evolution Dr David Evans Mr Paul Carroll, Deputy Director Medical Services, Senior Director, Program Delivery Directorate, Princess Alexandra Hospital,


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A Tale of an Application’s Evolution

The Future of The Electronic Discharge Summary

Dr David Evans Deputy Director Medical Services, Princess Alexandra Hospital, Brisbane Mr Paul Carroll, Senior Director, Program Delivery Directorate, HSIA, Queensland Health

HIC 2015

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The Holy Grail

  • One of the first elements of health informatics to

demonstrate how eHealth would impact clinical care, and in particular the continuum of care between facilities, specialists and primary care deliverers.

  • The Electronic

Discharge Summary was for many the Holy Grail of the electronic health record.

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De Dear ar Do Docto ctor…

The Past?

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  • Often no summary just a letter
  • Often illegible
  • Not loved by general practitioners.
  • Containing minimal useful information
  • Arrived long after the information was relevant
  • Poor quality of Information in any event.

De Dear ar Do Docto ctor…

Hard to see the way forward.

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Dear Doctor…

Dear Doctor Smith, Mr Jones is now

  • well. He is being

discharged home and I look forward to seeing him in a month. No change to his medication. All his tests were normal. Dr Peter Edwards.

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The Electronic Discharge Summary

The early electronic discharge summaries were simple word- processing templates with typed text filling text boxes with headings such as Presenting Complaint Current Medications and Past Medical History.

Then the Word Processor, Templates, Dragon Dictate …. We could see a way forward….

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The EDS arrived in Queensland!

  • Electronic delivery systems were created
  • Textual material came directly from patient

administration, surgery, pathology, imaging, and pharmacy systems

  • Reduced risk of transcription errors
  • Risk of mistaken identity substantially removed.
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Forms an essential element communication application and inherent aspect of The Viewer and Queensland’s SEHR as well as the National PCEHR

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The Queensland EDS

INSERT EDS Architecture image DH

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Discharge Summaries on PCEHR

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Valued Integrated Application

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The Electronic Discharge Summary

Still a long way from the Holy Grail, moved eHealth communication into the future with improved stakeholder understanding of where the future eHealth superhighway was likely to take them.

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Over the Horizon?

  • What of the future?
  • What issues will emerge as the Digital Hospital and the Digital Community

emerge?

  • Integration with hospital electronic medical records
  • The ongoing development of the national shared electronic record(s) (My

EHR or PCEHR)

  • Greater granularity in content
  • Integration with GP systems

Faster! Capacity!

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Over the Horizon?

  • Specialist and Outpatient letters,
  • Death Notifications,
  • Event Summaries,
  • Reports and e-referrals,
  • Interactive clinical pathways,
  • Multisite synchronised Telehealth clinical records

Document Creation Options? Seamless communication between clinicians, patients and providers?

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Ubiquitous Communication Technology Too much of a good thing??

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The Human Factor

  • The difference between a high and a poor

quality summary lies often with the author not the application.

  • The timeliness of a human moderated

summary can be disappointing when instant transmission is possible but completion may be days following discharge.

  • The selection of what is to be included or

excluded, its relevance, currency and accuracy remains in human hands - the senders not the receivers.

Enthusiasm for the new must be tempered by ongoing cognitive skills development and understanding by the authors.

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The Human Factor

  • The value of the communication requires

understanding of the patient’s and receiver’s needs, the criticality of the message, privacy and on-going relevance.

  • A quality dialogue is required between the

author and the reader.

  • Feedback and evaluation of the Discharge

Summary’s value and content will help the author to improve.

  • Role of auditing and application enhancement

Enthusiasm for the new must be tempered by ongoing cognitive skills development and understanding by the authors.

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Challenges

  • One-way message
  • Redundancy & 24x7
  • Bandwidth
  • NBN Rollout
  • Dependencies on distribution

channels and third party suppliers

  • Secure messaging (HIPS)
  • Integration with perpetual

storage solutions, suitable middleware & emerging application harmony.

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Challenges

PCEHR GPs TOTALS

Future?

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Challenges

  • National and International

Standards

  • Ensuring semantic

interoperability

  • Gaining professional agreement
  • n document structure,

templates, format, metadata

  • Use of Reference Terminologies
  • Meeting the long term

governance issues and costs.

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What is the next Holy Grail?

  • Need to be more responsive to receivers

requirements

  • Challenging to achieve a degree of consistency

from customer (GP) side

  • What elements are must have, nice to have,

waste of time?

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The Future …

EDS creates the historical summative care statements Continuum of care is a concept involving an integrated system of care that guides and tracks patient over time through a comprehensive array of health services spanning all levels of intensity of care.

Evashwick, C. (1988). Creating the continuum of care. Health Matrix, 7(1), 30-39.

The Continuum of care EHR will be an integrated system of care records that guides and tracks patient over a life time through a comprehensive array of health services application spanning all levels of intensity of care.

The Viewer is a portal into those records

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The Human - Machine Factor

Integration with EHR Codification, Inclusion & Definition of Metadata e.g.:

  • Author / role – example a cardiology intern
  • Procedure
  • Medication
  • Health conditions
  • Online guidance
  • Automated Care Paths
  • Pre-populated Content
  • Primary Care provider

preferences

  • Provide a menu of information
  • ptions
  • Improved final message
  • Targeted
  • Critical information included
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The Future …

Do we need an EDS?

  • Push – Pull
  • Ubiquitous access to whole medical record
  • Integrated with genomic profile, work and social history
  • Integrated chronic care plans and automated interventions by care

providers

  • The whole nature of clinical partnerships and patient consent

needs resolution.

  • Video and social network connections with providers
  • Real time automated messages to care team with shared records

The development of ubiquitous eHealth portals for access by clinicians, patients and carers may make transmission of documents or even messages redundant.

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  • Mr Jones admitted today (20/11/2014) via Emergency Department

contact 0733234561 Dr Thomas – use webconference link.

  • Mr Jones has been discharged home today (26/11/2014)
  • Mr Jones had a left hip replacement on 23/11/2014. More details at

https://hospitalwebportal.12345f.html: Code 3245

  • Appointment arranged at 3.30pm on 1/12/2014 at Dr Edwards for

follow up

  • Medication summary (including ceased and newly prescribed .

Enhanced real time messaging. Continuous, timely information flow.

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The Future … Do we need an EDS?

The EDS must eventually integrate into a single, shared secure eHealth system. The construct known as the Discharge Summary is difficult to produce and takes considerable time: One option – Take info from other systems (and send it direct as a message) versus current select from store and drop in to a container or template (The Summary) Minimal training

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The Future … Do we need an EDS?

Such freedom comes with:

  • Onerous security demands,
  • Prodigious and ongoing costs
  • Complex consent and governance issues
  • Perplexing identity issues for both consumers and providers.
  • Storage challenges
  • Information and Knowledge Management Issues

No matter our roadmap, the aim must always be to provide appropriate and timely information to enhance the handover of care.

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The End